PubMed Health⌕ Search

Biomedical subjects

P Hermanek

Publications and source records attributed to P Hermanek.

At least 19 recordsLinked to original sources
PubMed1995

[Postoperative complications and fatalities in surgical therapy of colon carcinoma. Results of the German multicenter study by the Colorectal Carcinoma Study Group].

In a prospective multicenter study an analysis of postoperative morbidity and mortality of 1224 patients with colon carcinoma treated in 7 departments of surgery was performed. The postoperative morbidity rate was 23.2% in elective surgery and 39.1% in emergency surgery. Postoperative mortality was 3.4% in elective cases and 11.6% in emergency cases. Preoperative associated diseases, which are more frequent in higher age, advanced tumor stage, and postoperative non-surgical complications rise operative mortality. However, surgical complications increase postoperative mortality only in cases of anastomotic leaks. The rates of postoperative complications depended on different surgical departments. Departments performing a delayed tumor resection in emergency surgery had better results. In elective cases the standard of oncological resections should be observed. In emergency cases operative procedure and extension of the resection should be planed in consideration of preoperative risk factors of the individual patient.

Adult↗
PubMed1994

Classification and regression trees (CART) for estimation of prognosis in patients with gastric carcinoma.

A total of 961 patients who had received resective surgery for gastric carcinoma were grouped according to prognosis by classification and regression trees (CART). This grouping was compared to the present UICC stage grouping. For patients resected for cure (R0) the CART approach allows a better discrimination of patients with poor prognosis (5-year survival rates 15%-30%) from patients with a 5-year survival of 50%, on the one hand, and from patients with extremely poor prognosis (5-year survival rates below 5%) on the other. In the present investigation CART grouping was not influenced by the differentiation between pT1 and pT2 or between pT3 and pT4.

Decision Trees↗
PubMed1994

[Is acrolentiginous melanoma (ALM) more malignant than superficially spreading melanoma (SSM) at a high-risk site? A matched-pair comparison between 113 ALM and SSM within the scope of a multicenter study].

Even today, the prognosis of acrallentiginous melanoma (ALM) remains a controversial topic. We present a large case study including all known factors relevant for prognosis. 113 ALMs in 3616 melanoma patients were paired as precisely as possible with their twins, i.e. with 113 superficial spreading melanomas (SSM) from a group of 619 SSMs with high-risk location. The ALMs and SSMs were equivalent in tumor thickness, patient gender and mode of treatment. The follow-up period was for at least 5 years. The 5-year Kaplan-Meier survival curve in both groups are identical. The poor prognosis often ascribed to ALM results from the prognostic factor location. ALM should therefore be regarded as acral localized melanoma.

Aged↗
PubMed1994

[Prognostic advantage for defined risk groups by lymphocyte dissection. Long-term study of 3,616 melanoma patients].

Nine medical centres with different practices in elective lymph node dissection (ELND) but comparable standards regarding diagnosis, excision of the primary tumour, classification, and follow-up, have collected their data on 3616 patients with primary melanoma of the skin (tumour category pT 2 to pT 4a, N 0, M 0 [UICC 1987] with the aim of producing an unbiased analysis of the prognostic benefit of ELND. The multivariate risk analysis (Cox's proportional hazard model) revealed tumour thickness (Breslow or alternative pT categories), sex, anatomic site of the primary tumour, and ELND therapy ("yes" or "no") as independent prognostic factors. Observed survival curves (Kaplan-Meier) show a significant difference of prognosis with regard to ELND therapy in the following risk groups: women with melanomas over 2.5 to 4 mm thick on head, neck, thorax, and in acral locations; men with melanomas over 1.5 to 4 mm thick on head, neck, thorax, and in acral locations; and finally men with melanomas over 2.5 to 4 mm thick on abdomen and extremities. Further investigations and the discovery of additional prognostic factors would help in more precisely formulation of guidelines for ELND.

Adult↗
PubMed1994

What's new in TNM?

As other parameters of tumor classification, TNM as well can never be considered definitive because advances in diagnosis and treatment as well as in knowledge of prognostic factors require adaption of current classifications. On the other side, the need for stability in tumor classification is obvious for accumulation of data in an orderly way over reasonable periods of time. The last edition of TNM, i.e. the fourth edition has been published in 1987 and was the result of an international effort to unify the classifications of Union Internationale Contre le Cancer (UICC) and American Joint Commission on Cancer (AJCC). Since 1987 changes in the classification for corpus uteri and vulva have been made by the Fédération Internationale de Gynécologie et d'Obstetrique (FIGO). This made a revision of the TNM classification necessary to ensure the complete agreement of TNM and FIGO classifications. In the revision 1992 some further changes were added for improvement. A further publication, namely the TNM Supplement 1993, available from November 1993, contains explanatory notes to enable a uniform use of TNM, proposals for new classifications and optional proposals for testing new telescopic ramifications. The latter are a way to collect data for further improvement of TNM and will be the first step for the preparation of the 5th edition, which will not be published until the year 2000. The aim of this publication is to inform pathologists on the essential changes in TNM as far as pathological classification is involved.

Humans↗
PubMed1994

The pathologist and the residual tumor (R) classification.

The R classification, adopted in 1987 by the UICC, denotes absence or presence of residual tumor after treatment. Residual tumor may be localized in the area of the primary tumor and/or as distant metastases. R0 corresponds to resection for cure or complete remission. R1 to microscopic residual tumor, R2 to macroscopic residual tumor. The R classification takes into account clinical and pathological findings. A reliable classification requires the pathological examination of resection margins. The R classification has considerable clinical significance, particularly being a strong predictor of prognosis. General and specific procedures for performing pathological R classification on resection specimens of different organs will be described. New methods in R classification comprise imprint cytology, cytolocial examination of ascites, examination of bone marrow biopsy. The importance of these methods will have to be established in the future.

Humans↗
PubMed1994

Prophylaxis of complications after pancreatic surgery: results of a multicenter trial in Germany.

Major pancreatic resection still carries a considerable risk for morbidity and even mortality. Complications occurring after pancreatic surgery are chiefly linked with exocrine pancreatic secretion. Therefore to inhibit exocrine pancreatic secretion perioperatively seems to be a promising concept in the prevention of complications following pancreatic resection. The hormone somatostatin and its synthetic analogue octreotide have been demonstrated to inhibit exocrine pancreatic secretion profoundly, particularly the secretion of proteases is decreased. In a randomized placebo-controlled multicentric and double-blind trial we analyzed the role of octreotide in the prevention of post-operative complications after major pancreatic surgery. A significant reduction of complications (fistula, abscess, fluid collection, sepsis, pulmonary insufficiency, postoperative acute pancreatitis) could be demonstrated in patients receiving octreotide (3 x 100 micrograms/day s.c.). The effect of octreotide was particularly true in patients undergoing a Whipple resection for cancer.

Austria↗
PubMed1994

[Long-term results of surgical therapy of colon cancer. Results of the Colorectal Cancer Study Group].

In a prospective multicentre observation study with free choice of treatment 1157 patients with solitary colonic carcinoma were entered free of selection between August 1984 and November 1986. The 5-year-survival rate for all patients was observed 45.7 +/- 3.0%, relative (age-corrected) 60.2 +/- 4.0%. Multivariate analysis using multiple logistic regression analysis identified R-classification, stage, institution and timing of surgery as independent prognostic factors regarding survival. In R0 resected patients occurrence of locoregional recurrence was the strongest prognostic factor. Study data could demonstrate a substantial variability in frequency of locoregional recurrence and survival among the participating institutions. The data support the importance of application of principles of radical surgery and gives evidence for the outstanding importance of surgery for the prognosis of colonic carcinoma.

Adenocarcinoma↗
PubMed1994

[Risk of surgical therapy of stomach cancer in Germany. Results of the German 1992 Stomach Cancer Study. German Stomach Cancer Study Group ('92)].

The German Gastric Cancer Study (GGCS '92) permits a representative pictures of the current situation in surgery for gastric carcinoma at university centers in Germany. The analysis of frequency of resection, complication rate and mortality provides a quality measure for anybody who performs surgical therapy for gastric carcinoma. The results of multivariate analyses will have therapeutic consequences.

Cause of Death↗
PubMed1994

[To what extent are laparoscopic procedures defensible in oncologic surgery?].

Successful oncological standard procedures can only be replaced by new methods if their value has been proven by long-term results. Laparoscopic tumor resections with curative intention have to be considered experimental, especially because long-term results are not yet available. These operations require two preconditions: 1) the oncological quality of tumor resection must be assessed by special methods of pathohistological examinations; and 2) long-term follow-up care must be guaranteed. In most cases, these preconditions are only secured within clinical trials.

Abdominal Neoplasms↗
PubMed1993

[Systematic extended lymph node dissection in curative therapy of stomach cancer].

On 545 patients with gastric carcinoma treated surgically for cure during June, 1, 1982 and December, 31, 1989 the value of the systematic extended lymph node dissection (SELD) was studied prospectively. In SELD neither surgical mortality nor postoperative complications were observed with increasing frequency. In stage II survival was significantly improved in patients with SELD, in stages IA, IB and IIIA an analogous trend was seen. Patients in stage IIIB and IV showed with and without SELD identical survival.

Adult↗
PubMed1992

Morphological predictors of survival in early and advanced gastric carcinoma.

In 351 patients with gastric carcinomas resected for cure, the relationship between macroscopic and microscopic features and survival was studied by univariate and multivariate analyses. In the multivariate survival analysis with covariates according to the Cox regression model, in early cancer all significant correlations to survival rate are covered by the stage grouping according to the UICC schedule of 1987. In advanced gastric carcinoma the UICC stage and, in addition, the Borrmann type and the intensity of cellular infiltration are effective. By additional consideration of these two variables an extended pathological staging schedule is proposed. It has the advantage of better discrimination between patients who differ in prognosis and seems to improve the prognostic prediction of outcome. Testing of this extended staging system in larger collectives is recommended.

Analysis of Variance↗
PubMed1992

Role of octreotide in the prevention of postoperative complications following pancreatic resection.

Though morbidity and mortality rates following pancreatic resection have improved in recent years, they are still around 35% and 5%, respectively. Typical complications, such as pancreatic fistula, abscess, and subsequent sepsis, are chiefly associated with exocrine pancreatic secretion. In order to clarify whether the perioperative inhibition of exocrine pancreatic secretion prevents complications, we assessed the efficacy of octreotide, a long-acting somatostatin analogue. We conducted a randomized, double-blind, placebo-controlled, multicenter trial in 246 patients undergoing major elective pancreatic surgery. Patients were stratified into a high-risk stratum (limited to patients with pancreatic and periampullary tumors) or low-risk stratum (patients with chronic pancreatitis). Patients received octreotide (3 x 100 micrograms) or placebo subcutaneously for 7 days perioperatively. Eleven complications were defined: death, leakage of anastomosis, pancreatic fistula, abscess, fluid collection, shock, sepsis, bleeding, pulmonary insufficiency, renal insufficiency, and postoperative pancreatitis. Two hundred patients underwent pancreatic head resection, 31 patients underwent left resection, and 15 patients had other procedures. The overall mortality rate within 90 days was 4.5%, with 3.2% in the octreotide group and 5.8% in the placebo group. The complication rate was 32% in the patients receiving octreotide (40 of 125 patients) and 55% in patients receiving placebo (67 of 121 patients) (p less than 0.005). In the patients in the high-risk stratum, complications were observed in 26 of the 68 (38%) patients treated with octreotide and in 46 of 71 (65%) patients given placebo (p less than 0.01). Whereas in patients in the low-risk stratum, the complication rate was 25% (14 of 57 patients) in those treated with octreotide and 42% (21 of 50 patients) in patients given placebo (p = NS). The perioperative application of octreotide reduces the occurrence of typical postoperative complications after pancreatic resection, particularly in patients with tumors.

Double-Blind Method↗
PubMed1992

[The dysplasia-carcinoma sequence in the colorectum].

The concept of dysplasia-carcinoma sequence has been established for the gastrointestinal tract. Dysplasia is defined as unequivocal neoplastic proliferation of epithelium without invasion and represents the precancerous lesions of the colon and rectum. The most common appearance of dysplasia is polypoid adenoma, however, flat adenomas are increasingly diagnosed. During the last 20 years, new pathological and biological methods including molecular genetics showed the stepwise evolution of colorectal carcinoma from normal mucosa to dysplasia of increasing grade and to invasive carcinoma. Of course, dysplasia-carcinoma sequence does not imply the development of carcinoma in every focus of dysplasia. In fact, the incidence of carcinomas from adenomas is 5-10%. A new molecular or genetic epidemiology promises an improved selection of high risk individuals.

Animals↗
PubMed1992

[1992 tumor classification/developments].

Surgical oncology must consider some new international and national publications: 1. New fascicles of the 2nd edition of the WHO International Histological Classification of Tumors. 2. The 1992 revision of the 4th edition of the UICC TNM Classification and of the UICC TNM Atlas. 3. The TNM Supplement 1992/93 (UICC), which includes, among other things, explanatory notes for uniform use, proposals for further development, and a compilation of prognostic factors other than TNM and R to be considered in clinical studies. 4. The fully revised and enlarged tumor documentation system of the Working Group of German Cancer Centers (Arbeitsgemeinschaft Deutscher Tumorzentren).

Documentation↗
PubMed1992

[Abdominal multivisceral resection of colonic cancer].

Multivisceral resection in combination with extended lymph node dissection is used in the surgical treatment of locally advanced colon carcinoma without distant metastases. This also applies to tumours with marked peritumorous inflammation in contact with neighbouring organs where an intraoperative diagnostic attempt could result in tumour seeding. The low mortality and complication rate following multivisceral resection justifies this concept. The 5-year survival rate following multivisceral resection in advanced colon carcinoma is over 80%.

Abdominal Neoplasms↗